Drop Off Form

Please complete the following drop-off form prior to dropping off your pet at our hospital. You may submit the form via the web form below or download the form and email a completed version to our team at help@lastablasAH.com.

Drop Off Date Details

Date of Drop-Off Appointment*

NOTE: Please call the hospital at 805-369-2222 to schedule your pet's drop-off appointment before submitting this form. Your drop-off request will not be confirmed until you've schedule the appointment with our reception team.

Date Format: MM slash DD slash YYYY

Preferred Pick-Up Time*

Client Name*

FirstLast

Patient Information

Patient Name*

Reason For Your Visit/Pet's Symptoms*

Pet's Current Medications*

Pet's Weight*

Is Normal

Has Increased

Has Decreased

If there has been a change in your pet's weight, when did it start?

Pet's Appetite*

Is Normal

Has Increased

Has Decreased

If there has been a change in your pet's appetite, when did it start?

Pet's Water Intake*

Is Normal

Has Increased

Has Decreased

If there has been a change in your pet's water intake, when did it start?

Pet's Urination*

Is Normal

Has Increased

Has Decreased

Pet's Urine Color*

Is Normal

Is Light

Is Dark

If there has been a change in your pet's urination or urine color, when did it start?

Pet's Stool*

Is Normal

Has Increased

Has Decreased

Pet's Stool Quality*

Is Normal

Is Runny

Is Soft

Is Hard

Is Offensive in Odor

If there has been a change in your pet's stools, when did it start?

My Pet Has Been (please check all that apply)*

Vomiting

Sneezing

Coughing

My Pet is Not Exhibiting Any Of These Symptoms

If your pet is vomiting, sneezing or coughing, when did it start?

Has your pet been exposed to toxins or medications?*

Yes

No

If your pet has been exposed to toxins or medications, what was it and when?

Diagnostic Authorization

Please select one of the options below and let us know if you would like to pre-authorize diagnostics and treatments.

Authorization for Diagnostic Treatment*

Please select one option.

I authorize any diagnostics and/or treatments up to $400.00

I authorize any diagnostics and/or treatments up to the amount indicated below.

Please call me with an estimate prior to any diagnostics or treatments.

I authorize any diagnostics and/or treatments up to the amount below:*

Contact Information

Our Hospital

We are centrally located in Templeton, right off the 101 freeway. Las Tablas Animal Hospital is looking forward to providing you and your pets with our quality veterinary services. It’s our goal to bring a higher quality of medical care to the pets in the area as well as outstanding customer care for their owners. Visit us and you will see what experienced, compassionate veterinary care really feels like!